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NiacinAka: Nicotinic Acid, Simcor, Advicor, Cordaptive

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  1. Indications
    1. Low HDL Cholesterol
    2. Hypertriglyceridemia
    3. Combination therapy with Statin for Hyperlipidemia
  2. Effects
    1. HDL increased (15-35%)
      1. No other agent raises HDL as much as Niacin
    2. Triglycerides decreased (20-50%)
    3. LDL Cholesterol decreased (10-25%)
      1. Significantly lowers LDL only at high dose
      2. Not a first-line agent for lowering LDL
  3. Efficacy
    1. Reduces Myocardial Infarction and coronary death risk
    2. References
      1. Canner (1986) J Am Coll Cardiol 8:1245
  4. Adverse effects
    1. Flushing
    2. Pruritus
    3. Skin irritation of neck and face
    4. Gastrointestinal upset
    5. Blurred vision
    6. Fatigue
    7. Glucose intollerance
    8. Hyperuricemia and gout
    9. Peptic Ulcer Disease exacerbation
    10. Hepatic toxicity with sustained release forms
  5. Compliance and tolerance
    1. Poor Compliance: 40% discontinue use
    2. Reduced Flushing and Pruritus reaction
      1. Use Aspirin or Ibuprofen pretreatment
      2. Take dose with food
  6. Contraindications
    1. Absolute
      1. Chronic Liver Disease
    2. Relative
      1. Type II Diabetes Mellitus
      2. Severe gout
      3. Hyperuricemia
  7. Preparations: Niacin
    1. Crystalline Niacin
      1. Dose: 1g PO tid ($5.50/mo) MAX: 6 g/day
      2. Example protocol (Use 500 mg tablets)
        1. Start: 250 mg at bedtime
        2. Titrate up over 6 weeks to 500 mg tid
      3. Pretreatment: Aspirin 81 mg before or Ibuprofen
    2. Niaspan (preferred)
      1. Safest of niacins (only 4% GI side effects)
      2. More expensive than crystalline niacin
      3. Example protocol for initiating doses
        1. One 500 mg tablet PO qhs for 1 month
        2. Two 500 mg tablets PO qhs for 1 month
        3. One 1000 mg tablet PO qhs for 1 month
        4. Check lFTs, Uric Acid, glucose at 3 months
        5. Two 1000 mg tablets PO qhs
      4. References
        1. McBride (2003) New Therapeutics Lecture, Cable, WI
    3. Agents to avoid
      1. Avoid flush-free or no-flush Niacin
      2. Avoid Slow Niacin (Sustained Release)
        1. Decreased Safety due to hepatotoxicity
  8. Preparations: Niacin combined with other agents
    1. Advicor: Niaspan (500-1000 mg) and Lovastatin (20-40 mg)
    2. Simcor: Niaspan (500-1000 mg) and Simvastatin (20 mg)
    3. Cordaptive: Niacin (extended release) with Laropiprant (to reduce Flushing)
  9. Monitoring: Monitor while checking dose
    1. Glucose
    2. Liver transaminases
    3. Uric Acid
  10. References
    1. Meyers (2003) Ann Intern Med 139:996

Niacin (C0027996)

Definition (MSH)A water-soluble vitamin of the B complex occurring in various animal and plant tissues. It is required by the body for the formation of coenzymes NAD and NADP. It has PELLAGRA-curative, vasodilating, and antilipemic properties.
Definition (CSP)nicotinic acid (3-pyridinecarboxylic acid) and its derivatives; a water soluble B vitamin which is the precursor of NAD and NADP.
Definition (PDQ)A water-soluble vitamin belonging to the vitamin B family, which occurs in many animal and plant tissues, with antihyperlipidemic activity. Niacin is converted to its active form niacinamide, which is a component of the coenzymes nicotinamide adenine dinucleotide (NAD) and its phosphate form, NADP. These coenzymes play an important role in tissue respiration and in glycogen, lipid, amino acid, protein, and purine metabolism. Although the exact mechanism of action by which niacin lowers cholesterol is not fully understood, it may act by inhibiting the synthesis of very low density lipoproteins (VLDL), inhibiting the release of free fatty acids from adipose tissue, increasing lipoprotein lipase activity, and reducing the hepatic synthesis of VLDL-C and LDL-C. Check for "http://www.cancer.gov/Search/ClinicalTrialsLink.aspx?id=38351&idtype=1" active clinical trials or "http://www.cancer.gov/Search/ClinicalTrialsLink.aspx?id=38351&idtype=1&closed=1" closed clinical trials using this agent. ("http://nciterms.nci.nih.gov:80/NCIBrowser/ConceptReport.jsp?dictionary=NCI_Thesaurus&code=C689" NCI Thesaurus)
Definition (NCI)A water-soluble vitamin belonging to the vitamin B family, which occurs in many animal and plant tissues, with antihyperlipidemic activity. Niacin is converted to its active form niacinamide, which is a component of the coenzymes nicotinamide adenine dinucleotide (NAD) and its phosphate form, NADP. These coenzymes play an important role in tissue respiration and in glycogen, lipid, amino acid, protein, and purine metabolism. Although the exact mechanism of action by which niacin lowers cholesterol is not fully understood, it may act by inhibiting the synthesis of very low density lipoproteins (VLDL), inhibiting the release of free fatty acids from adipose tissue, increasing lipoprotein lipase activity, and reducing the hepatic synthesis of VLDL-C and LDL-C.
ConceptsOrganic Chemical (T109) , Pharmacologic Substance (T121) , Vitamin (T127)
English3 Pyridinecarboxylic Acid, Antipellagra factor, Niacin, Niacin preparation, Nicotinic Acid, Nicotinic acid preparation, Nicotinic acid product
Spanishácido nicotínico, acido nicotinico, factor antipelagra, niacina, preparado con ácido nicotínico, preparado con acido nicotinico, preparado con niacina
CreditsDerived from the NIH UMLS (Unified Medical Language System)



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